Provider Demographics
NPI:1154059830
Name:KIRTLEY, SUMMER ANN (NP, CNS)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:ANN
Last Name:KIRTLEY
Suffix:
Gender:F
Credentials:NP, CNS
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:ANN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, CNS
Mailing Address - Street 1:1444 MAIN ST UNIT 1585
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-8153
Mailing Address - Country:US
Mailing Address - Phone:909-319-3324
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR # 8929
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1911
Practice Address - Country:US
Practice Address - Phone:909-319-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA639490163WP0200X
CA4447364SP0200X
CA21777363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics